Effectiveness of anti-osteoporotic medications in the management of glucocorticoid-induced osteoporosis: a systematic review and network meta-analysis on behalf of the ECTS clinical action group
Authors' conclusion
This network-meta-analysis demonstrates a clear gradient of efficacy among AOM in GIOP, with anabolic and potent antiresorptive-medications producing the largest gains in lumbar-spine aBMD
Study context
- Population
- Adults receiving oral glucocorticoids (glucocorticoid-induced-osteoporosis (GIOP) prevention and treatment); age range 29.6–70.6 years, 72.5% females31 studies (28 RCTs, 3 observational)
- Participants
- 5,260 adults
- Comparison
- Anti-osteoporotic medications (anti-osteoporotic-medications (AOM)) compared with each other and with placebo or calcium/vitamin D
- Outcome
- Percentage change in lumbar-spine aBMD
Methodological detailsPRISMA-NMA, random effects, direct and indirect comparisons, CINeMA certainty assessment
- PRISMA-NMA
- Random effects
- Direct and indirect comparisons
- CINeMA certainty assessment
Pooled result
As reported in the abstract
Lumbar-spine aBMD % change
Effect-size
- Teriparatide vs Alendronate
- 3.8 (95% CI 2.9–4.6)
- Teriparatide vs Risedronate
- 4.0 (95% CI 2.9–5.1)
- Teriparatide vs Denosumab
- 1.5 (95% CI 0.1–2.9)
- Teriparatide vs Zoledronate
- 2.4 (95% CI 1.1–3.6)
- Teriparatide vs Romosozumab · no significant difference
- 0.3 (95% CI −2.1 to 1.4)
Further pooled results
Sensitivity analysis: established GIOP (glucocorticoids (GC) users ≥3months)
- Teriparatide and romosozumab remained superior to antiresorptive medications
Total-hip and femoral-neck areal bone- mineral-density (aBMD)
- Evidence limited by substantial network inconsistency (mostly missing data)
Fractures
- Included studies were underpowered to assess differences in fracture outcomes
Original publication
Effectiveness of anti-osteoporotic medications in the management of glucocorticoid-induced osteoporosis: a systematic review and network meta-analysis on behalf of the ECTS clinical action group. Eur J Endocrinol. Published 7 August 2026. doi:10.
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